Sh’ma Koleinu:
A Sermon on Mental Illness
Yom Kippur, 5764
Rabbi Esther Adler-Rephan
Mount Zion Temple
Imagine my surprise…I never would have expected it. The press release
reads: Reform Movement Commends President Bush.
It’s true. The UAHC Commission on Social Action and The Religious
Action Center wrote a letter to President Bush applauding him for his statement
that
“Our country must make a commitment: Americans with mental illness
deserve our understanding, and they deserve excellent care.”
I never would have expected it: I commend President Bush. I applaud
him for establishing the New Freedom Commission on Mental Health, and for
saying
“Americans must understand and send this message: mental disability is
not a scandal – it is an illness. And like physical illness, it is treatable,
especially when the treatment comes early.”
The Commission on mental Health was established in April, 2002. In July
of this year, they presented their report, a 120 page document calling for a
“fundamental transformation of the nation’s approach to mental health care.”
On page 1, the commission states its vision:
“We envision a future when everyone with a mental illness will recover,
when mental illnesses can be prevented, or detected early and treated,
and when everyone with a mental illness at any stage of life has access to
effective treatment and supports enabling them to live, work, learn, and
participate in the community.”
From their mouths to God’s ears.
Did you know that nationally, mental illness affects 1 in 5 families, and that
each year 1 in 7 people will suffer from clinical depression? And though we’d
rather deny it, the numbers are the same for the Jewish community.
Which means that just about every one of us knows somebody who has
been personally touched by mental illness. In Jewish law there is a category
called “Noge’a badavar,” literally touching the matter, in other words, a
concerned party. Where mental illness is concerned, whether we like it or not,
we are all noge’a badavar.
You are, and the person next to you is, and I am. Members of my family
have been hospitalized for mental illness; members of my family have had eating
disorders, members of my family have attempted suicide; one, tragically,
succeeded. Members of my family and many of my friends suffer with
depression. I have wrestled with depression. Now, every person in this room
knows somebody who has been touched by mental illness.
I apologize and ask your forgiveness if you are feeling uncomfortable right
now. Nobody really is comfortable talking about mental illness. Rabbi Karen
Sussan, Jewish chaplain at the Middletown Psychiatric Center has written,
“When I started working here I [used to] call it the Looney Bin… I knew it was
wrong, but I was uncomfortable and frightened.” Rabbi Sussan had consciously
and deliberately chosen to make the Psych patients her congregation, and even
she was afraid.
The Ba’al Shem Tov taught: fear builds walls which bar the light. In the
case of people with mental illness, our fear of them builds walls which we hope
will protect us, yet which really just bar the divine light which shines forth from
them, the divinity in each of us which defines our humanity.
The second half of today’s Torah portion began with the command “Re’eh,
See!”…In every service we recite “Shema Yisrael –Listen, Israel!” Judaism is
telling us, unequivocally, that we must open our eyes, and our ears, that we must
be willing to see and hear the people crying out to us from behind those walls of
fear.
Who are they? Occasionally, very rarely, they are the disturbed person
with a gun in the public square. But more often, much more often, they are the
people we love whose brain chemistry combines with the stresses of everyday
life to impair their thinking, mood or behavior.
The types and degrees of mental illness are as varied as the types and
degrees of physical illness. We would never lump everybody with physical
illness into one homogeneous group; we all understand that metastatic cancer
and bronchitis and are different. Sadly, though, we do tend to lump all who live
with mental illness together and think they should all look, behave, and be
treated the same.
Mental illness is really a misnomer, because it is by no means one illness.
It is any disorder of the brain that affects thinking, mood or behavior. It is
depression, it is anxiety, it is eating disorders, Alzheimer’s, and autism. It is
schizophrenia, bipolar, post-traumatic stress, seasonal affective disorder. It is
substance abuse and sleep disorders. It is even ADHD. It can be mild or
moderate or severe, it afflicts the rich and the poor, men and women, young and
old, the educated and the unschooled.
One thing that does seem to generalize to all the mentally ill is the stigma
attached. Though it’s not a symptom, stigma is perhaps the most pervasive and
devastating aspect of mental illness. It is the stigma which silences and isolates,
which keeps people from seeking treatment and support, which ultimately can
turn an otherwise manageable condition into a devastating, and even deadly one.
A generation ago, cancer carried such a stigma. The word wasn’t spoken
aloud. Aunt Goldie has (whispered:) cancer. Today cancer is a household word.
Our B’nai Mitzvah give their Tzedakkah money to cancer research. Even Ronald
McDonald is on board.
A decade ago, AIDS carried such a stigma. Today we go on marches and
bike rides; AIDS awareness calls to us from the side of busses and billboards.
Today, mental illness is a silent killer. In ten years, in a generation, will we
be rallying around the search for a cure? Will we be wearing ribbon pins and
making giant quilts and raising money? Will we at least be talking about it?
We don’t talk about now it because we’re still too afraid. Sufferers are
afraid to be judged. They’re afraid to be served facile solutions which are
impossible for them: “You just need to cheer up.” “Why don’t you learn to control
yourself?” “If you’d just change your attitude…” Telling a depressed person to
just cheer up is like telling a nearsighted person to just see better.
Family members are afraid too. They are afraid to be blamed, accused, or
shunned for something which is not their fault.
We would never judge someone who uses insulin to regulate their
endocrine imbalance; what justifies our judging of someone who takes Prozac to
regulate their seratonin?
If you fell and broke your leg, you would be taken to the hospital where
you would be treated, and then sent home to bed. Later you would get rehab to
regain your strength. You’d probably receive cards and flowers and visits from
friends. But if a loss or crisis caused you break down emotionally or mentally,
chances are you would be feared, isolated, ignored. Nobody might bring you
flowers or even take you to the doctor; if you stayed in bed you would be told to
stop feeling sorry for yourself.
The stigma of mental illness keeps people from getting the help they need.
What if instead, we treated a broken mind like a broken leg? What if we
encouraged and facilitated treatment, assumed a good chance of recovery, and
allowed time for healing?
There’s another problem: Often mental illness is hard to recognize. A
broken leg is easy to diagnose, even for a layperson. Strep throat and heart
disease can be confirmed by lab tests. But there is no lab test for depression. It
is hard to tell exactly when sadness or grief morph from healthy responses into
debilitating illness. It is hard to know whether somebody is quirky or autistic,
energetic or manic, dieting or suffering from anorexia.
And even when we can tell, even when we know, then the shame and fear
kick in and we look away, we deny, we pretend, we grasp at straws rather than
label a loved one “mentally ill.”
We have come to abhor labeling, and rightly so. Often it is confining,
sometimes dehumanizing. But if labeling is negative, naming is positive.
Naming is important. Naming is essential.
One of the first things God does on the first day of creation is to name.
“And God called the light day, and the darkness, God called night.” And one of
the first things Adam does in the Garden is to name: “And the man gave names
to all the cattle and to the birds of the sky.” Naming things, places, and people is
a very important theme in the Torah.
And names can change – Abraham and Sarah start out as Abram and
Sarai; Jacob’s becomes Israel. Each name change reflects a change in
experience and personality. Even God’s name changes throughout Torah.
So we shouldn’t be so shy of naming things. It has been said that naming
affirms the existence of a thing. By naming the depression or the anxiety or the
eating disorder we do not lock someone into a lifelong prison of labels, rather we
affirm the existence of a problem, thereby affirming the possibility of its solution.
If we refuse to name it, we may deny its existence, but it doesn’t go away, and it
doesn’t get treated.
Like physical illness, most forms of mental illness can be successfully
managed with the right treatment, though finding it can often involve a long and
challenging process of trial and error. One source said people spend an average
of eight years seeking help for their mental disorders before receiving a correct
diagnosis and treatment.
But that does not mean we can give up. Although research into how the
brain works is just beginning, scientists have made remarkable strides in
understanding and treating many mental disorders. Statistically, psychiatry has a
higher success rate than many other branches of medicine.
And like with physical illness, healing does not come from only one
source. When we recite the MiSheberach prayer, we ask God for "refua shleima:
complete healing – refuat hanefesh urefuat haguf: healing of body and healing of
spirit." Plato said: "As you ought not to attempt to cure the eyes without the head or
the head without the body,” he says, “so neither ought you to attempt to cure the
body without the soul." Healing comes when we treat the whole person, mind,
body, and spirit together.
Caring for the spirit is known in our tradition as Bikkur Cholim, and it is
something we can all do. The Talmud teaches that a visitor can take away part of
a sick person's pain, and enough love might eradicate it entirely (Nedarim). We
care for the spirit by reaching out in genuine caring and love.
The Jewish Healing Program has recently offered a special course in
providing Bikkur Cholim to people with mental illness. One of our own
congregants has completed it and is ready to go.
But spiritual care for the
mentally ill is not that different from spiritual care for the physically ill.
It is reminding them that they are not alone by making them and their
families feel welcome and valued in the community; it is offering loving support as
they seek medical and psychological treatment. It is even offering a ride, making
a meal or helping with the shopping.
Bobbie Nemer, an outspoken advocate for people suffering with
depression, and a dear friend of mine, told me that when she is depressed, she
needs to be continually reminded that she is loved, that she will not be
abandoned, and that life goes on. She may not be able to believe it at the time,
yet hearing it still gives her hope.
As family, friends, and caregivers, we must remember that although we
probably cannot change the course of the illness, and certainly not instantly or
even quickly, we need to persevere. We need to persist even when our efforts to
comfort, cheer and cajole aren’t working. Hillel taught Lo alecha hamlacha
ligmor, v’lo atah ben horin l’hibatel mimena: It is not up to you to complete the
task, neither are you free to abandon it.
Hillel was wise. He also taught Im Ain ani li mi li: If I am not for myself,
who will be for me? These words speak volumes to people dealing with mental
illness:
Individuals suffering from mental illness, especially depression, often
cannot be for themselves. The illness takes away that ability, and so we, friends
and family and community need to take over, at least temporarily, and to help
them seek treatment and to keep seeking no matter how long it takes, to
encourage them to take their medications, to remind them that there is always
something else to try.
And the people closest to someone with mental illness often forget to be
for themselves, or feel guilty if they are. Hillel is telling us that if we do not take
care of ourselves, we will not be able to care for another. He is telling us to take
a break, go to a movie or a yoga class or a walk around the lake. He is telling us
to join a family support group. He is telling us to know and respect our limits.
Although our mental healthcare system is, to quote the President’s
commission, “a patchwork relic,” and woefully inadequate, we do have resources
in our community. We are blessed to have the Mental Health Education Project,
a collaborative effort of all the major Jewish agencies and organizations. It offers
us resources, training, information and support.
Every other Wednesday night, JFCS sponsors an ongoing Depression
and Mania Support Group at the St. Paul JCC. It is free and open to the
community.
October 9, this Thursday, is national Depression Screening Day,
designed to call attention to depression, manic-depression, Post-traumatic Stress
disorder, and anxiety, to educate the public about symptoms and treatments, of
offer screening for the conditions, and to connect those in need of treatment with
health care providers. There are a number of sites in the Twin cities offering this
free service.
On November 16, the Mental Health Education Project is sponsoring the
third community-wide conference, this one entitled “Opening closed doors:
coping with mental illness in the family.”
You can find information on the Project, the conference, and the screening
day in our lobby.
Mental illness can be pervasive, insidious, destructive. The people who
suffer with it can be draining, demanding, and frustrating, as well as inspiring,
loving, and grateful. Mental illness is never easy to cope with, and yet we must.
Judaism demands it of us. And Judaism can help us – to find support in
community, hope in prayer and strength in God.
And so, as a community we pray:
Avinu Malkeinu, Sh’ma koleinu: Avinu Malkeinu hear our voice. Hear our
cries of despair, our calls for help. Hear our voices even when we cannot lift
them up to you.
Avinu Malkeinu, Chatanu l’fanecha: We have missed the mark. Forgive
us when we succumb to fears and stereotypes, when we isolate, judge, or shame
those who need us most.
Avinu Malkeinu, chaneinu va’aneinu, Ki ain banu ma’asim: Be gracious to
us for our deeds are not always in our control. Answer us when we call for parity
in research, treatment, and insurance.
Aseh imanu Tzedakka vachesed v’hoshienu: Treat us generously and
with kindness and be our help. Help us to find the treatment and support we
need. Help our scientists to learn more about the causes and treatments of
mental illness. Teach us to respond with generosity and kindness to those who
need our help.
Avinu Malkeinu, shma koleinu,
Avinu Malkeinu, hear our voice.
Avinu Malkeinu, heal us.